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NPI Code Detail

MEDICARE: DR. JEFFREY REX SUMSION DMD, MS

MEDICARE: DR. JEFFREY REX SUMSION DMD, MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry145258-9921UT

General Provider Information

NPI Number : 1396962981
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY REX SUMSION DMD, MS
Provider Business Mailing Address
First Line : 4585 SILVER SPRINGS DR
Second Line :
City : PARK CITY
State : UT
Zip : 84098-5913
Country : US
Telephone Number : 435-649-0099
Fax Number :
Provider Business Practice Location Address
First Line : 4585 SILVER SPRINGS DR
Second Line :
City : PARK CITY
State : UT
Zip : 84098-5913
Country : US
Telephone Number : 435-649-0099
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2007
Last Update Date : 07/08/2007

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